Disorders of the Mediastinum: Student/Resident Case Report Poster - Disorders of the Mediastinum |

Thymic Carcinoma Presenting as Myasthenia Gravis FREE TO VIEW

Subhash Yadav, MD; Ricardo Salonga, MD; Jose Edzel Tamayo, MD; Leila Magsino, MD; Cherry Ann Dionzon-Serra, MD
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University of Perpetual Help Dalta Medical Center, Las Pinas, Philippines

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):546A. doi:10.1016/j.chest.2016.08.564
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SESSION TITLE: Student/Resident Case Report Poster - Disorders of the Mediastinum

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Thymic carcinoma is a rare disease of the anterior mediastinum. Rarer still is Thymic carcinoma associated with Myasthenia Gravis. Due to its rarity, its treatment is not fully established. Here we are presented with a patient presenting not as Thymic carcinoma at the outset, but with signs of Myasthenia Gravis, eventually diagnosed with Thymic carcinoma.

CASE PRESENTATION: A case of 46 year old female admitted due to generalized body weakness. 8 months prior, she noted voice changes and started to feel more tired. She had ptosis which lead us to suspect diagnosis of Myasthenia Gravis, confirmed by repetitive nerve stimulation study. Chest MRI showed a mediastinal mass, thus referred to TCVS and underwent median sternotomy with partial thymectomy, pericardiostomy with pericardial window. A 10x8 cm enlarged thymus gland with encroachment and extension to pericardium was found. Specimens were sent for histopathology which showed Thymic carcinoma. She underwent chemotherapy and adjuvant radiotherapy. A chest CT scan after radiation therapy was done, with significant decrease of tumor size. Eventually she improved.

DISCUSSION: Myasthenia Gravis is characterized by weakness and fatigability of skeletal muscles, usually associated with Thyroid disease, Hodgkin’s Lymphoma & Thymic gland abnormalities, with 85% as Thymic hyperplasia while 15% are Thymic tumors. Thymic tumors are composed of Thymomas, Neuroendocrine tumors and Thymic carcinomas. For most physicians, behavior of Thymic carcinoma is often confused with Thymoma due to its heterogeneous histology and rarity. Kelly reported Thymic carcinomas account for less than 1% of Thymic tumors. Surgery is the treatment of choice. According to Kondo, patients with advanced Thymic carcinoma who underwent both total and subtotal resection alone had 5-year survival rate of 30-67%. A study by Chen, using concurrent chemoradiotherapy, 16 patients with unresectable Thymic carcinoma was treated with debulking and chemoradiation, 5-year survival rate was 67.7%. Our patient suffered from Thymic carcinoma but she also had Myasthenia Gravis. What then is the incidence of Thymic carcinoma presenting as Myasthenia Gravis? Liu reported, 7.9% of patients with Thymic carcinoma had Myasthenia Gravis. Kondo reported, 2.2 % of 186 patients with Thymic carcinoma having Myasthenia Gravis. We did a literature review of 6 other studies on Thymic carcinoma of 247 cases from 1974 to 2003; none were associated with Myasthenia Gravis.

CONCLUSIONS: Patients with Myasthenia Gravis having Thymic carcinoma are rare. We present a case of Myasthenia Gravis diagnosed as Thymic carcinoma.

Reference #1: Kondo K, et al. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg (2003) 76:878-84

Reference #2: Ronan J. Kelly. Systemic Treatment of Advanced Thymic Malignancies,ASCO Educational Book 2014, : e367-7

Reference #3: Chung DA. Thymic carcinoma-analysis of 19 clinic pathological studies. Thorac Cardiovasc Surg 2000;48:114-9

DISCLOSURE: The following authors have nothing to disclose: Subhash Yadav, Ricardo Salonga, Jose Edzel Tamayo, Leila Magsino, Cherry Ann Dionzon-Serra

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